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Home-Based Programs and Cardiac Rehabilitation Participation Among Veterans With Ischemic Heart Disease
Linda G Park1,2,3, Ning Zhang2,4, David W Schopfer5
1Department of Community Health Systems, School of Nursing, University of California, San Francisco (UCSF), San Francisco.
Importance:
Cardiac rehabilitation (CR) is a guideline-recommended secondary prevention program that reduces morbidity and mortality among patients with ischemic heart disease (IHD) yet remains underutilized. Over the past decade, the Veterans Health Administration (VHA) has implemented strategies to increase CR participation, including expansion of virtual home-based CR (HBCR) programs as alternatives to traditional center-based CR (CBCR).
Objective:
To examine temporal trends and factors associated with CR participation among veterans with IHD.
Design, Setting, And Participants:
This cohort study used national VHA electronic health record data to evaluate CR participation among veterans hospitalized for IHD, identified using International Classification of Diseases, Ninth Revision (ICD-9), ICD-10, or Current Procedural Terminology codes from 2012 to 2022. Data were analyzed from October 25, 2025, to July 25, 2026.
Exposures:
Availability of CR delivery models at Veterans Affairs (VA) facilities, including referral to community care programs only, VA CBCR, or VA HBCR.
Main Outcomes And Measures:
The primary outcome was the proportion of eligible veterans with acute myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft surgery who participated in any type of CR within 12 months of the index event, identified using Current Procedural Terminology codes and VA stop codes from VA-provided, VA-purchased, or Medicare-claimed services. Multivariable logistic regression was used to identify factors associated with CR participation.
Results:
Among 405 907 veterans with IHD (mean [SD] age, 68.5 [11.1] years; 391 998 men [96.6%]), 63 185 (15.6%) participated in CR. Participation increased from 9.6% in 2012 to 17.1% in 2022, with a peak of 19.7% in 2018. In 2022, participation was higher at facilities offering HBCR (20.0%) compared with those offering CBCR without HBCR (14.8%) or referral to community care programs only (14.3%). The adjusted odds ratio (AOR) of participation among veterans treated at facilities offering HBCR was 1.80 (95% CI, 1.75-1.84), whereas the AOR of participation at facilities offering CBCR without HBCR was 1.29 (95% CI, 1.26-1.32) compared with referral to community care programs only.
Conclusions And Relevance:
In this cohort study of veterans with IHD, participation in CR nearly doubled between 2012 and 2022. Patients who had index events at facilities offering HBCR had higher CR participation than those at facilities offering CBCR without HBCR, or at facilities offering only referral to community care. Broader availability of HBCR programs may help improve participation within large health systems.